子宫腺肌病与子宫肌瘤310例的临床相关及对比分析

目的 对310例子宫腺肌病与子宫肌瘤患者进行临床相关及对比分析，以利于指导临床治疗与诊断。方法回顾性分析了310例子宫腺肌病与子宫肌瘤的临床资料。结果 两者大多数见于30—50岁生育年龄的妇女（P〉0．05）。而与子宫肌瘤相区别的是，子宫腺肌病的临床表现为痛经、盆腔深部痛或性交痛，盆腔检查子宫增大多〈2个半月，活动度差，后穹隆有触痛，血清CA125增高，术前误诊率高。两者相比，差异有显著性（P〈0．05）。结论 二者共同的发病因素可能是高雌激素刺激。术前诊断子宫腺肌病应在结合病史、临床症状及盆腔检查的同时，结合B超、血清CA125测定等检查，进行综合判断。     

血清CA125检测在子宫内膜异位症中的表达与意义

目的探讨血清Cancer antigen125（CA125）的测定对术前子宫内膜异位症及其与子宫腺肌症，盆腔炎并存的诊断价值。方法回顾性分析91例术前检测血清CA125值，术后病理证实为子宫内膜异位症、子宫腺肌症、盆腔炎。结果子宫内膜异位症、子宫内膜异位症合并子宫腺肌症、盆腔炎血清CA125的测定值逐渐升高；但在统计学上差异均无显著性。结论测定血清CA125的值对诊断子宫内膜异位症及子宫内膜异位症合并子宫腺肌症、盆腔炎有一定的临床价值。     

超声结合血清EMAb在子宫腺肌病及子宫肌瘤诊断中的应用价值

目的 探讨超声检查结合血清EMAb测定对诊断子宫腺肌病及子宫肌瘤的价值. 方法 对61例子宫腺肌病及70例子宫肌瘤患者分别经腹及经阴道行彩色多普勒超声检查.同时用放免法测定患者血清EMAb.超声诊断结果与血清EMAb水平测定结果分别与术后病理进行对照. 结果 超声诊断与术后病理诊断对照子宫肌瘤组符合率高于子宫腺肌病组(P<0.01).血清EMAb水平与术后病理对照诊断符合率子宫腺肌病组明显高于子宫肌瘤组(P<0.01). 结论 超声和血清EMAb结合监测对子宫腺肌病及子宫肌瘤的诊断有应用价值.     

子宫腺肌症的MRI诊断价值探讨

目的探讨子宫腺肌病的MRI表现及MRI扫描的诊断价值。方法对19例经手术病理证实的子宫腺肌症患者行MRI检查并回顾性分析。结果19例中，弥漫性子宫腺肌症11例，子宫壁结合带弥漫性增厚，结合带与肌层分界不清；在T1WI上表现为等信号，在T2WI上表现为等或略低信号，混杂有散在多发点状高信号灶。局限性子宫腺肌症8例，表现为子宫体部或底部局限性增大，相应部位结合带增厚，与肌层分界不清，在T1WI上呈等信号，T2WI上呈略低信号，病灶信号可不均匀，中央部可有多发点状高信号。结论MRI能对子宫腺肌症作出明确诊断，矢状位T2WI是显示病变的最佳扫描序列。     

缩宫素对子宫良性病变滋养血管频谱变化的超声观察

目的超声观察子宫肌瘤及局限性子宫腺肌病应用缩宫素前后滋养动脉频谱形态变化，评价肌层良性病变子宫对缩宫素的反应。方法子宫肌瘤（30例）及局限性子宫腺肌病（15例）静滴缩宫素（0．04U／min）前后行彩超检查，对比滋养动脉频谱形态变化。结果应用缩宫素后，子宫肌瘤（24／30）及局限性子宫腺肌病（10／15）出现异型频谱，包括单向楔形、单向圆钝、双向楔形及热带鱼样等；子宫肌瘤及局限性子宫腺肌病频谱变化包括异型持续（19／30，6／15）、异型交替（5／30，4／15）、正常舒缩变化（6／30，5／15）；不同类型肌瘤周边与内部动脉均出现频谱变化；所有患者子宫弓状动脉与双侧子宫动脉均未检测到频谱变化。结论多普勒超声检测滋养动脉频谱形态变化有助于评价肌层良性病变子宫对缩宫素的反应；异型频谱的出现可能是由于子宫肌层收缩导致滋养血管发生狭窄或痉挛。     

Tumor Vascular Pattern and Blood Flow Impedance in the Differential Diagnosis of Leiomyoma and Adenomyosis by Color Doppler Sonography

Purpose: Our objective was to evaluate the differences between leiomyoma and adenomyosis by color Doppler sonography with new criteria. Methods: A total of 78 patients with symptomatic uterine nodularities who were sonographically suspected to have leiomyoma or adenomyosis without other coexisting pathologic conditions was enrolled in the study. All patients underwent transvaginal color Doppler sonography (7.0-MHz vaginal probe) or transabdominal color Doppler sonography (5.0 MHz) during the early follicular phase. The morphology, tumor vascular pattern, and blood flow impedance of the uterine tumors were measured. All of the patients underwent surgery and the pathologic reports were used as references. Results: The mean age was not statistically significant in patients with adenomyosis versus leiomyoma (P > 0.05). The morphologic criteria for adenomyosis and leiomyoma by sonography detected 79% of adenomyosis and 84% of leiomyoma. Adenomyosis had 87% randomly scattered vessels or intratumoral signals and 88% of leiomyomas showed peripheral scattered vessels or outer feeding vessels. Eighty-two percent of adenomyoses had a pulsitility index (PI) of arteries within or around uterine tumors >1.17 and 84% of leiomyomas had a PI 1.17. The reliability test of tumor vascular pattern and blood flow impedance were better than that of using morphological criteria alone. Conclusions: With the aid of color Doppler sonography, tumor vascular pattern and blood flow impedance of the arteries within or around uterine tumors could more accurately diagnose adenomyosis and leiomyoma in addition to the morphologic criteria on transvaginal sonography.     

Biological differences between focal and diffuse adenomyosis and response to hormonal treatment

Research question

Is there any difference in ovarian steroid receptor expression and pattern of fibrosis in focal and diffuse adenomyosis and response to hormonal treatment?

Usefulness and limits of CA-125 in diagnosis of endometriosis without associated ovarian endometriomas

BACKGROUND: The aim of this study was to evaluate the diagnostic significance of CA-125 for endometriosis without ovarian endometriomas. METHODS: Preoperative serum CA-125 levels were measured in 775 consecutive women diagnosed by laparoscopy or laparotomy with endometriosis, adenomyosis, leiomyomas, or normal pelvis. RESULTS: Receiver operating characteristic curve analysis revealed that the area under the curve for endometriosis without endometriomas was 0.788, significantly smaller than that for endometriosis with endometriomas (0.935, P < 0.05). In diagnosis of endometriosis without endometriomas, both the maximal accuracy of 78.8% and the maximal diagnostic value of 61.2% were obtained at the cutoff value of 20 U/mL. Negative predictive value was 78.0% at the cutoff value of 20 U/mL, whereas positive predictive value was 92.9% at the cutoff value of 30 U/mL. This range is clearly superior to the empirical single cutoff of 35 U/mL. CONCLUSIONS: In the diagnosis of endometriosis without endometriomas, combined use of two cutoff values for CA-125, 20 and 30 U/mL, provides improved diagnostic performance. However, the accuracy of using only CA-125 testing for diagnosis is still limited. Serum CA-125 testing can be done during initial screenings of women with possible endometriosis.     

Subserous uterine adenomyosis mimicking an adnexal mass on sonography

Uterine adenomyosis usually manifests as diffuse disease involving the myometrium and the endometrial-myometrial junction, but it may also manifest as a focal lesion. It is usually only a few millimeters in diameter but may sometimes be larger. We report the case of a 32-year-old woman with a large isolated mass in the uterine wall. Transvaginal sonography demonstrated the cystic nature of the mass and its characteristic hemorrhagic pattern, whereas CT confirmed its uterine origin. The patient underwent laparoscopic resection of the mass, and pathologic examinations led to the diagnosis of adenomyosis.     

Relationship between endometriotic foci and nerves in rectovaginal endometriotic nodules

The histological relationships between fibrotic tissue, endometriotic foci and nerves in the rectovaginal septum endometriotic or adenomyotic nodule were studied. This is considered to be one of the most severe forms of deep endometriosis. Masson's trichrome staining for fibrosis detection and immunohistochemistry with the S100 monoclonal antibody for nerve detection were performed in 28 rectovaginal endometriotic nodules from patients presenting with severe dysmenorrhoea and deep dyspareunia (23 patients with no other endometriotic location or potential cause of pain at laparoscopy and ultrasonography; five patients with multiple pelvic endometriotic localizations and other potential causes of pain at laparoscopy). Patients were allocated to two groups on the basis of their preoperative pain scores for pelvic pain, dysmenorrhoea and deep dyspareunia (group 1, score >7; group 2, score < or =7). For each symptom, the mean number of nerves and endometriotic lesions per high-power field and the mean largest diameter of the lesions were not statistically different in groups 1 and 2. The mean percentages of nerves located within the fibrosis of the nodule and within endometriotic lesions were significantly higher in group 1 than in group 2. Among nerves located within endometriotic lesions, there was a significantly higher proportion showing intraneurial and perineurial invasion by endometriosis in group 1 than in group 2. In rectovaginal endometriotic nodules, there was a close histological relationship between nerves and endometriotic foci, and between nerves and the fibrotic component of the nodule. We postulate that such topographical relationships could at least partially explain the strong association between this lesion and pain.